[Risk stratification of patients with diabetes mellitus]

Area of Science:

• Endocrinology
• Healthcare Management
• Public Health

Context:

• Managing chronic diseases like diabetes mellitus requires effective collaboration between general practitioners (GPs) and hospitals.
• Optimizing patient follow-up pathways is crucial for efficient healthcare delivery.
• Risk stratification criteria can guide the distribution of care responsibilities.

Purpose:

• To evaluate a risk stratification model for optimizing specialist shared care in patients with diabetes mellitus.
• To compare the model's risk stratification with actual patient follow-up status.
• To assess the suitability of the model for different risk levels.

Summary:

• A study in southern Denmark risk-stratified 647 diabetes patients into three follow-up levels: GP-only, intensified GP/shared care, and out-patient clinic-only.
• The model identified high-risk patients for specialized care but was less effective for lower-risk groups.
• Actual follow-up varied, with a notable percentage of patients having higher risk profiles than initially stratified.

Impact:

• The findings suggest the model's potential for selecting high-risk diabetes patients for specialized out-patient clinics.
• The model requires modification for broader implementation, particularly for patients with low or moderate risk.
• This research can inform strategies for improving the distribution of care for chronic disease management.